Tomato flu outbreak in India: a need for precautionary measures in dental treatment
Authors: Saravanan Sekaran, Dhanraj Ganapathy
Journal: International Journal of Surgery (2023)

Dear Editor, As of 21 August 2022, India has recorded 82 cases of Tomato flu (TF) in youngsters under the age of 5 and 26 cases in children aged below 10. This has alerted people all around the world to the possibility of a fresh epidemic in India. It may be a complication of childhood dengue or chikungunya fever rather than a viral infection1. It may be a novel strain of the viral hand, foot, and mouth disease caused by Coxsackie virus2,3. Children are primarily vulnerable since viral infections are common in them; but, if they are not treated and avoided, they may also have harmful consequences on adults4. The TF is very contagious, much like other influenza types. Close touch is the most probable means of transmission. Its primary signs and symptoms resemble those of chikungunya, including high fever, rashes, and agonizing joint pain. The painful, red blisters that spread widely and finally grew to the size of tomatoes gave the disease its name. These blisters resemble those that patients who have the monkeypox virus experience. Additional symptoms and indicators include fatigue, nausea, vomiting, diarrhea, fever, dehydration, joint swelling, and body aches, which are comparable to those of other viral infections. In addition, these symptoms are similar to those of other viral illnesses including dengue4,5. Five to 7 days after the onset of symptoms, confinement must be utilized to stop the virus from spreading. The best preventative strategy involves practicing excellent hygiene, sanitizing the nearby area, and preventing the sick child from exchanging items with other kids who are well. Drug repurposing and vaccination are the most effective and economical ways to protect the general populace against viral infections, especially in children, the elderly, and those with compromised immune systems. There are currently no antiviral drugs or vaccinations that can be used to treat or prevent TF. To better comprehend the morphology of the virus and possible therapeutic options, long-term follow-up is required6. Dental treatment in patients with TF can be very challenging. This infection can start as a rash or blister in perioral and oral mucosa also, in which cases the role of dentists in identifying this in their differential diagnoses and guiding the patients to appropriate medical care becomes paramount. Active dental treatment including endodontic, periodontic, prosthodontic, and restorative procedures should be deferred until complete recovery. However, emergency extraction procedures should be carried out with total personal protection equipment. Biomedical waste and tissues should be properly discarded by protected incineration. Antibiotics and analgesics can be prescribed to manage pain. Patients should be instructed to practice meticulous oral hygiene with individual toothbrushes. These toothbrushes should be discarded immediately after recovery from TF illness. In India, with 70% population distributed in the rural areas with dental clinics of less stringent practices followed, the spread of TF is largely expected. Therefore, a proper guidelines is essential to curb its transmission. To enlighten clinicians, medical personnel's and other hospital staff's readers further, we share a few more additional suggestions that are followed at our dental clinic. It's crucial to use protective gear, such as personal protective equipment and N95 respirators while working with procedures that create aerosols. Restricting the use of tower fans, air blowers, and air conditioners in hospitals. Reducing the number of outpatient visits by giving high priority to patients who need urgent care, such as trauma patients. Instead of communal treatment space, patients who require treatments should get them in a private setting. Patients with suspected or confirmed TF should postpone elective dental operations until they are no longer infectious. Limited contact with all tools and supplies used to treat TF patients. Equipment used in patient care must be adequately sterilized. Overall, restraining the spread of TF in outpatient and trauma units, maintaining regular surgical volumes, and providing treatment to all patients regardless of health should be the key healthcare objectives. Ethical approval None. Sources of funding None. Authors' contribution All authors devised the concept, performed the literature search, and drafted the letter. Conflicts of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) None. Guarantor None. Data Statement None.